Patients with Mild Traumatic Brain Injury Recruited from Both Hospital and Primary Care Settings: A Controlled Longitudinal Magnetic Resonance Imaging Study

Abstract

With an emphasis on traumatic axonal injury (TAI), frequency and evolution of traumatic intracranial lesions on 3T clinical magnetic resonance imaging (MRI) were assessed in a combined hospital and community-based study of patients with mild traumatic brain injury (mTBI). The findings were related to post-concussion symptoms (PCS) at 3 and 12 months. Prospectively, 194 patients (16–60 years of age) were recruited from the emergency departments at a level 1 trauma center and a municipal outpatient clinic into the Trondheim mTBI follow-up study. MRI was acquired within 72 h (n = 194) and at 3 (n = 165) and 12 months (n = 152) in patients and community controls (n = 78). The protocol included T2, diffusion weighted imaging, fluid attenuated inversion recovery (FLAIR), and susceptibility weighted imaging (SWI). PCS was assessed with British Columbia Post Concussion Symptom Inventory in patients and controls. Traumatic lesions were present in 12% on very early MRI, and in 5% when computed tomography (CT) was negative. TAI was found in 6% and persisted for 12 months on SWI, whereas TAI lesions on FLAIR disappeared or became less conspicuous on follow-up. PCS occurred in 33% of patients with lesions on MRI and in 19% in patients without lesions at 3 months (p = 0.12) and in 21% with lesions and 14% without lesions at 12 months (p = 0.49). Very early MRI depicted cases of TAI in patients with mTBI with microbleeds persisting for 12 months. Patients with traumatic lesions may have a more protracted recovery, but the study was underpowered to detect significant differences for PCS because of the low frequency of trauma-related MRI lesions.

Association of cause of injury and traumatic axonal injury: a clinical MRI study of moderate and severe traumatic brain injury

“…Both 3-T scanning 31 and SWI 1,13 increase the sensitivity for lesion detection, which could possibly have led to both higher occurrence and grades of TAI. On the other hand, a recent study from our research group using both 3-T scanning and SWI within 72 hours found TAI lesions in only 6% of patients with mild TBI, 8 compared to 74% of patients with moderate and severe TBI in the current study. Hence, 1.5-T scanning and T2*GRE may be sufficiently sensitive to detect visible TAI lesions in moderate and severe TBI.…”

Systemic Inflammation Persists the First Year after Mild Traumatic Brain Injury: Results from the Prospective Trondheim Mild Traumatic Brain Injury Study

“…The cohort and magnetic resonance imaging (MRI) follow-up have been described in detail previously. 12,13 All data were handled in accordance with the STROBE checklist ( Supplementary Fig. S1).…”

“…The clinical scans were read by an experienced neuroradiologist according to predefined criteria as described in a previous publication. 13…”

Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery

“…Intracranial traumatic findings were obtained from Magnetic Resonance Imaging (MRI), performed within 72 h. MRI was performed on a 3.0 Tesla Siemens Skyra system (Siemens Healthcare, Erlangen, Germany) with a 32-channel head coil. The MTBI was classified as uncomplicated if there were no intracranial traumatic lesions on MRI, as described in detail previously ( 23 ). All patients in the present study underwent MRI.…”

“…All patients in the present study underwent MRI. In addition, CT was performed in the majority of the patients, but none of the patients had intracranial findings on CT that were not detected on MRI (23).…”